Clinical Endoscopy

Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea: Jung Wan Choe, Jong Jin Hyun, Seong-Jin Son, Seung-Hak Lee; Clin Endosc 2024;57(4):476-485. Published online April 12, 2024; DOI: https://doi.org/10.5946/ce.2023.198

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Sedation has become a standard practice for patients undergoing gastrointestinal (GI) endoscopy. However, considering the serious cardiopulmonary adverse events associated with sedatives, it is important to identify patients at high risk. Machine learning can generate reasonable prediction for a wide range of medical conditions. This study aimed to evaluate the risk factors associated with sedation during GI endoscopy and develop a predictive model for hypoxia during endoscopy under sedation.
Methods
This prospective observational study enrolled 446 patients who underwent sedative endoscopy at the Korea University Ansan Hospital. Clinical data were used as predictor variables to construct predictive models using the random forest method that is a machine learning algorithm.
Results
Seventy-two of the 446 patients (16.1%) experienced life-threatening hypoxia requiring immediate medical intervention. Patients who developed hypoxia had higher body weight, body mass index (BMI), neck circumference, and Mallampati scores. Propofol alone and higher initial and total dose of propofol were significantly associated with hypoxia during sedative endoscopy. Among these variables, high BMI, neck circumference, and Mallampati score were independent risk factors for hypoxia. The area under the receiver operating characteristic curve for the random forest-based predictive model for hypoxia during sedative endoscopy was 0.82 (95% confidence interval, 0.79–0.86) and displayed a moderate discriminatory power.
Conclusions
High BMI, neck circumference, and Mallampati score were independently associated with hypoxia during sedative endoscopy. We constructed a model with acceptable performance for predicting hypoxia during sedative endoscopy.

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Do Patients with Pancreatic Hyperenzymemia without Abnormal Imaging Need Additional Endoscopic Ultrasound?: Jung Wan Choe, Jong Jin Hyun; Clin Endosc 2019;52(2):97-99. Published online March 14, 2019; DOI: https://doi.org/10.5946/ce.2019.044

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Treatment of Traumatic Esophagopleural Fistula Using the Over-the-Scope-Clip System: Ji Hyoung Kim, Jong-Jae Park, Il Woo Jung, Sang Hoon Kim, Hee Dong Kim, Jung Wan Choe, Moon Kyung Joo, Hyun Gu Kim; Clin Endosc 2015;48(5):440-443. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.440

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Esophagopleural fistula (EPF) is a rare condition that is usually accompanied by severe infection and life-threatening morbidity. Here, we report the successful treatment of an EPF by closing an esophageal orifice using the over-the-scope-clip (OTSC) system without postprocedural complications. A 41-year-old man had serious thoracic and abdominal trauma due to a traffic accident. Computed tomography revealed findings suggestive of esophageal rupture due to Boerhaave syndrome. An emergent explorative operation was performed for primary repair with the insertion of a vacuum-assisted closure device. A postoperative upper gastrointestinal series revealed an EPF tract connecting the left pleural space and distal esophagus. We performed an endoscopic procedure using the "traumatic-type"OTSC to seal the EPF, and the esophageal orifice was completely healed 2 weeks postoperatively. The OTSC system might represent a safe and feasible modality for the treatment of EPF.

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